Lisfranc fracture

Lisfranc fracture is almost always accompanied by dislocation of the Lisfranc joints or the tarsometatarsal joints that are located in the middle of the foot. A twisting fall or a heavy blow can cause this fracture. Connective tissues or ligaments hold the bones in place. The first and second metatarsals are not held by any connective tissue. Hence when a twisting fall occurs, dislocation of these bones takes place. Due to this injury the tarsal bones are dislocated, but (MT) does not occur always. Generally, the fracture and the dislocation are treated independently with stabilization devices. One or more of the tarsometatarsal joints are dislocated when Lisfranc dislocation occurs.

Many times, mistaken for sprains, Lisfranc fractures are associated with swelling of the top of the foot which is also very painful. It is very difficult to put any weight on the foot if the injury is very severe. Often X-rays do not reveal Lisfranc injuries. Serious complications like joint degeneration and compartment syndrome will follow when Lisfranc injuries go unrecognized. If the pain or swelling does not reduce in spite of normal treatment for a sprain, it is better to take the advice of an orthopaedic specialist.

By examining the foot for signs of injury, an orthopedist will move the foot in a circular motion holding the heel steady. A CT scan or MRI scan will show the exact nature of the injury. Open Reduction Internal Fixation (OR IF) is advised for dislocation.

Ankle Injury

Injuries of the ankle while indulging in sports or some other activity can be termed as ankle injury. The most common ankle injury is an ankle sprain and occurs due to an injury i.e. either a tear, twist or overstretch of the ligaments. The most often sprained joint is the ankle joint. A stretch of the ligament causes a minor sprain and a severe sprain is a result of tearing of the ligament itself. Common causes for an ankle sprain:

• Ankle sprain occurs when the foot or heel twists inwards when compared to the lower leg thereby causing a stretch for the ligaments outside the ankle. This is termed as inversion sprain. If the foot or heel twists outwards, which is uncommon that condition is referred to as eversion sprain.
  
• People who have weak muscles in the lower leg
  
• People who have loose ligament in the ankle
  
• People who have sprained their ankle earlier and did not let it heal completely have chances of spraining the same ankle yet again.
  
• Sprains are common while climbing the stairs or while walking on uneven surfaces.
  
• People who wear high heeled shoes or slippers have more chances to sprain if they slip off their footwear while walking.
  
• While running, jumping, during a game of football or tennis, ankle injuries are common.

Symptoms of ankle sprain include severe pain at the site of the injury and inflammation and possible bruising. There is trouble in moving the joint. Other than cases of severe ankle sprains where professional help is required, an ankle sprain can be treated by self care. The most common method followed for ankle sprain is RICE:

• R: Rest. Rest the injury by limiting moving around and keeping weight off the affected place at least for 24-48 hours from when the injury has occurred.
  
• I: Ice. Place ice in a bag and apply on the affected area, this will bring down the inflammation, pain and bruising of the area. Apply ice once in two hours for twenty minutes.
  
• C: Compression. Compress the joint by applying a bandage; take care to apply the bandage firmly and not tightly.
  
• E: Elevation. Put up the injured leg right above the level of the heart, this brings a lot of relief, particularly during the nights.

Medications prescribed by the doctor would include non-steroidal anti-inflammatory drugs such as ibuprofen. The physician will ask for a x-ray and according to the extent of the injury advice for physical therapy and recommend support for the ankle through taping or bracing of the ankle. Very severe damage to the ligament might call for a surgery to repair the same.

Prevention from ankle injury

• Wear right fitting shoes or slippers.
  
• Warm up before getting into vigorous sports activities.
  
• Eat a healthy diet to keep your muscles and bones strong.
  
• Maintain a healthy weight and balance your weight appropriately while you walk, run or jump.
  
• Watch out while you walk on uneven surfaces and slippery surfaces.
  
• Wear the right shoes and use the right sports equipment while you practice a sport.
  

Carpal tunnel syndrome

CTS) is a condition that affects the hand and the wrist. It can result from injury to the wrist - dislocated or broken wrist bones or sprains. Carpal Tunnel Syndrome can also be caused by diabetes, rheumatoid arthritis or thyroid disease. Those who are at increased risk are computer users, violinists, golfers, meat packers, assembly line workers, hair stylists and mechanics since they perform the same hand movements repeatedly.

The median nerve controls some of the muscles that move the thumb. It also provides sensations of temperature, pain and touch from the hand to the brain as well as sweating of the hand. CTS results when the tunnel walls are compressed, thereby putting pressure on the nerve. Carpal tunnel syndrome is particularly associated with tasks that involve:

Repeated wrist movement
Awkward hand positions
Strong gripping
Stress on the palm
Use of vibrating tools

Lubrication is essential for the normal and smooth functioning of the tendons. With excessive or repetitive activity on the carpal tunnel, the lubrication system may malfunction. It may not produce enough fluid or it may produce a fluid with poor lubricating qualities. This failure creates friction between the tendon and its sheath causing inflammation and swelling of the tendon area.

The swelling squeezes the median nerve in the wrist or carpal tunnel. Repeated episodes of inflammation cause fibrous tissue to form. The fibrous tissue thickens the tendon sheath and hinders tendon movement. This makes moving of the wrist or the hand painful.

Symptoms of this condition usually start gradually - frequent burning, tingling, pins and needles or itching and numbness in the palm of the hand and the fingers especially the thumb and the index and middle fingers. In time, these symptoms can spread to the arm and shoulder. They tend to worsen at night or first thing in the morning since many people sleep with flexed wrists.

Carpal tunnel syndrome can affect one or both hands and the severity of the symptoms can vary. The hand muscles may become weakened, making it difficult to grip objects. It can also result in permanent loss of feeling. Fine finger movements, such as writing, may become increasingly difficult. In extreme cases patients might feel tingling during the day and the muscles at the base of the thumb may waste away. In some chronic cases people are unable to tell between hot and cold by touch.

Carpal tunnel exercises should be done by individuals who perform hand-intensive jobs. These exercises should be performed at the start of each workday and during a break. It reduces the amount of pressure on the median nerve in the carpal tunnel and prevents injury. A few important exercises for avoiding the carpal tunnel syndrome are discussed below:

• The most important thing to do is to get up from your desk and move around every 1/2 hour
  
  
• Extend and stretch both wrists and fingers acutely as if they are in a handstand position
  
  
• Straighten both wrists and relax fingers
  
  
• Make a tight fist with both hands and bend both wrists down.
  
  
• Take your arms out to the sides with the palms facing down. Extend your fingers and stretch through the elbows. On exhaling, rotate your shoulders back and bring the palms facing up.